Lre Bereznicki

Improving the outcomes of anticoagulation in rural Australia: an evaluation of pharmacist-assisted monitoring of warfarin therapy

Objective:  The aim of this project was to assess whether rural pharmacist involvement in the management of patients receiving warfarin has the potential to lead to safer and more effective anticoagulation, and is valued and welcomed by patients and their general practitioners (GPs).

PPI use in patients commenced on clopidogrel : a retrospective cross-sectional evaluation

Background/Aims:  Antiplatelet therapy with aspirin and clopidogrel is an important component of the management of acute coronary syndrome, but it also increases the risk of bleeding. There are no formal guidelines about the use of a proton pump inhibitor (PPI) for gastroprotection in patients on clopidogrel. This study assessed how many patients in the Royal Darwin Hospital (RDH) and the Royal Hobart Hospital (RHH) prescribed clopidogrel and at risk of bleeding were co‐prescribed PPIs.

Evaluation of antithrombotic usage for atrial fibrillation in aged care facilities

Summary What is known and Objective:  Warfarin is an important drug for the prevention of thromboembolic events such as stroke in patients with atrial fibrillation (AF). However, it is commonly implicated in major adverse drug events, which may result in reluctance to prescribe warfarin, especially in the institutionalised elderly population. This study aimed to assess the current trends in the antithrombotic management of AF in aged care facilities (ACFs) in Tasmania, Australia, and to compare this with current recommendations. Methods:  We performed a non-experimental, retrospective cohort study designed to evaluate antithrombotic usage for AF in ACF residents in Tasmania. Residents with AF were identified on a patient-by-patient basis from residential case-note summaries collected from 29 of the 64 ACFs in Tasmania. The CHADS-2 score and the presence or absence of documented contraindications were used to determine the appropriateness of the current antithrombotic therapy prescribed. Results and Discussion:  Fifteen per cent (262/1737) of the ACF residents were diagnosed with AF. Nine per cent of the residents with AF had a contraindication to antithrombotic therapy (either warfarin or antiplatelet therapy). Eighty-one per cent of residents were eligible for treatment with warfarin according to the CHADS-2 score and did not appear to have a contraindication to warfarin. Of these, only 38% were prescribed warfarin; 16% (40/255) did not receive any antithrombotic treatment, despite being eligible for treatment with warfarin or antiplatelet therapy. Residents who did not receive any antithrombotic treatment or who received antiplatelet treatment were significantly older than those treated with anticoagulants. What is new and Conclusion:  Our results indicate that antithrombotic therapy, particularly warfarin, is underused in ACF-dwelling elderly patients who are eligible for treatment.What is known and Objective:  Warfarin is an important drug for the prevention of thromboembolic events such as stroke in patients with atrial fibrillation (AF). However, it is commonly implicated in major adverse drug events, which may result in reluctance to prescribe warfarin, especially in the institutionalised elderly population. This study aimed to assess the current trends in the antithrombotic management of AF in aged care facilities (ACFs) in Tasmania, Australia, and to compare this with current recommendations.

Warfarin management after discharge from hospital: a qualitative analysis.

What is Known and Objective:  Warfarin is recognized as a high‐risk medication for adverse events, and the risks are particularly heightened in the period immediately following a patient’s discharge from hospital. This qualitative study aimed to explore the experiences of Australian patients and healthcare professionals of warfarin management in the post‐discharge period and identify the benefits and deficiencies of existing systems, to inform the development of a model for a new collaborative post‐discharge warfarin management service.

Thromboprophylaxis following hip and knee arthroplasty

To determine local thromboprophylaxis prescribing practices following arthroplasty.

Pain intensity and pain self-management strategies following discharge after surgery: An Australian prospective observational study

Up to 80% of patients experience acute pain following surgery. This study aimed to improve the current understanding about the strategies individuals use to self‐manage pain following discharge after surgery, stratified by pain intensity.

Home medicines reviews in Australian war veterans taking warfarin do not influence International Normalised Ratio control.

The clinical outcomes of warfarin are largely dependent on the international normalised ratio (INR) control achieved, and strategies to improve the time in therapeutic range (TTR) should be identified and widely implemented in practice.

Mortality from adverse drug reaction-related hospitalizations in south-west Ethiopia: A cross-sectional study

Adverse drug reactions (ADRs) are an important cause of mortality during medical care. To our knowledge, no Ethiopian studies have reported on mortality due to ADRs in patients presenting to hospital from the community setting. The aim of this study was to determine the mortality rate attributable to ADRs in patients presenting to hospital, identify drugs implicated in the ADR‐related deaths and identify factors contributing to ADR‐related mortality at Jimma University Specialised Hospital (JUSH), south‐west Ethiopia

Evidence‐to‐practice gaps in the management of community‐dwelling Australian patients with ischaemic heart disease

Ischaemic heart disease (IHD) is a major cause of death in developed countries. Patients with IHD are at greater risk of subsequent myocardial infarction (MI). International studies suggest that guideline recommended therapies proven to reduce this risk are underutilised. The objectives of this study were to review the use of guideline‐recommended medications for the secondary prevention of IHD in Australians and identify patient characteristics influencing use of these medications.

PPI use in patients commenced on clopidogrel

Background/Aims:  Antiplatelet therapy with aspirin and clopidogrel is an important component of the management of acute coronary syndrome, but it also increases the risk of bleeding. There are no formal guidelines about the use of a proton pump inhibitor (PPI) for gastroprotection in patients on clopidogrel. This study assessed how many patients in the Royal Darwin Hospital (RDH) and the Royal Hobart Hospital (RHH) prescribed clopidogrel and at risk of bleeding were co‐prescribed PPIs.